No abstract

IMPORTANCE Nasal valve compromise is a major cause of nasal obstruction, and multiple methods have been developed to address it. OBJECTIVE To compare nasal airflow resistance, airflow partitioning, and mucosal cooling (heat flux) before and after 2 surgical interventions, butterfly and spreader graft placement, used to treat nasal valve compromise. DESIGN, SETTING, AND PARTICIPANTSIn this cadaveric tissue study, 4 fresh cadaveric heads underwent both spreader graft and butterfly graft surgical procedures in alternating sequence in March 2016. Preoperative and postoperative computed tomographic scans were used to generate 3-dimensional (3-D) models of the nasal airway. These models were then used in steady state computational fluid dynamics simulations of airflow and heat transfer during inspiration. INTERVENTION Butterfly and spreader graft techniques.MAIN OUTCOMES AND MEASURES Nasal airflow resistance, airflow partitioning, and heat flux.RESULTS Donors 1, 2, and 3 were white males; donor 4, a white female. Computational fluid dynamics simulations during inspiration in 3-D models generated from preoperative and postoperative computed tomographic scans of the 4 cadaveric heads indicated reductions from preoperative values in nasal airflow resistance associated with both butterfly grafts (range, 20%-51%) and spreader grafts (range, 2%-29%). Butterfly grafts were associated with a greater reduction in nasal airflow resistance in models of all 4 cadaveric heads. Changes from preoperative values for heat flux, a biophysical variable that correlates with the subjective sensation of nasal patency, were more variable, ranging from −11% to 4% following butterfly grafts and −9% to 10% following spreader grafts. The preoperative airflow allocation in the left and right nostrils improved consistently with the butterfly graft. With the spreader graft, there were improvements for donors 1 and 4, but the allocations were worse for donors 2 and 3. CONCLUSIONS AND RELEVANCEThe results of this study suggest that the more recently developed butterfly graft technique may be associated with a similar level of improved nasal airflow as that observed with the use of a spreader graft in nasal valve compromise. Both interventions were associated with comparable changes in heat flux. Because this study addressed only static internal nasal valve stenosis, even greater differences in air flow and heat flux between the 2 techniques may be anticipated in a dynamic model. Further investigation in patients is warranted.LEVEL OF EVIDENCE NA.

Background: Deficits in somatostatin-like immunoreactivity (SLI) and corticotropin-releasing factor immunoreactivity (CRF-IR) are well recognized as prominent neurochemical deficits in Alzheimer disease (AD). The question of whether these profound neuropeptidergic deficits found in patients with end-stage disease extend into those with much earlier disease is relatively unanswered. To determine the relation between level of SLI and CRF-IR in different cerebrocortical regions to the earliest signs of cognitive deterioration in AD.

Purpose of review There are many well-established principles and surgical techniques for nasal reconstruction. The purpose of this paper is to describe contemporary reconstruction of nasal defects. The unique anatomic features of the nose make this a challenging task. While obtaining an optimal aesthetic result is always the goal of reconstruction, maintenance and restoration of nasal function are of equal importance. Recent findings The first step of nasal reconstruction is a thoughtful analysis of the defect. The best surgical option will provide the patient with an excellent aesthetic result and nasal function. Depending upon the extent of the defect as well as the anatomic site, a local flap, full-thickness skin graft, composite graft, or interpolated flap will provide the optimal result. The decision will depend on surgeon's experience and expertise, as well as expectations and desires of the patient. Many cutaneous defects will require not only reconstruction of the defect, but also cartilage grafts to provide nasal contour and support. Most large or complex defects will require a paramedian forehead flap for reconstruction along with cartilaginous and/or bony support, as well as a lining flap. Summary This article will highlight recent advances in nasal reconstruction and novel modifications of well-accepted traditional techniques.

Objective Information on polymorphous low-grade adenocarcinoma (PLGA) consists primarily of case reports and small institutional series with varying recurrence rates. In this report, we describe our institutional experience and conduct a review of the literature to assess the overall incidence of PLGA among oral salivary gland tumors and determine recurrence rates. Study Design A retrospective case series and literature based review was performed. Methods Retrospective case series at an academic tertiary referral center. Review of clinical records and pathological analysis of tissue specimens from 20 patients treated for PLGA from July 1, 1990 to July 1, 2011. A literature-based review on PLGA was also performed. Results Twenty patients (mean age 54 years, 8 males) with PLGA based on pathologic diagnosis were included. The most common initial presentation was an asymptomatic mass (45%) and the most frequent site was the palate (60%). Our literature review identified 54 case reports, 8 case series, and 17 large series. In total 456 cases of PLGA were identified with an overall recurrence rate of 19%. Half of the recurrences occurred by 36 months; however, recurrences were reported up to 24 years after initial resection. Conclusion PLGA arises from minor salivary glands and is characteristically slow growing and indolent. While these tumors may be histologically low-grade, our review highlights the high rates of recurrence of these tumors as well as the ability to metastasis to local lymph nodes and distant organs. The mainstay of treatment should be wide surgical excision with long-term oncologic follow up.